September 6, 2011 — Mammography and breast palpation remain important tools for detecting breast cancer, even for women under the age of 50, according to the results of a large analysis. In addition, the results validated the importance of annual screening mammography in women aged 50 years and older.
Highlights of the study were presented at a press briefing given in advance of the start of the 2011 Breast Cancer Symposium, being held in San Francisco, California.
In a cohort of almost 6000 women with breast cancer, 65.5% of breast cancers were detected by mammography, 29.8% by palpation, and 4.7% by other methods.
In women under the age of 50 years, approximately half of the tumors (48.3%) were detected by mammography, while a similar percentage of tumors (46.1%) were detected by palpation.
Almost all of the breast cancers detected by palpitation were detected by the patient, as compared with those detected by a clinician.
Of note, women with palpable tumors tended to have more advanced cancers, as compared with those whose tumors were detected by mammography, and this was applicable to women age 40 to 49 years and those over age 50, explained lead author Jamie Caughran, MD, medical director of the Comprehensive Breast Center at the Lacks Cancer Center in Grand Rapids, Michigan.
The authors also found that women with tumors detected by palpation were more likely to undergo mastectomy (46%) than those with tumors found via mammography (27%). Similarly, women with tumors detected by palpation were also more likely to undergo chemotherapy (22.7%) than those detected by mammography (15.7%).
Lower Rate of Mastectomy and Chemotherapy
This is very important work for a number of reasons, commented Andrew Seidman, MD, American Society of Clinical Oncology Cancer Communications Committee member.
"There has been controversy — depending on your perspective or data presented in individual studies or in large overviews — regarding the utility of screening in younger women," said Dr. Seidman, who served as the moderator of the press briefing. "We do know that younger women have denser breast tissue, which can impact or reduce the sensitivity as compared to older women. But it certainly doesn't negate the utility of mammography as a screening test."
Dr. Seidman pointed out that much of the debate and focus regarding the utility of mammography have been on its impact on overall survival and breast cancer–specific survival.
"That is certainly the most important endpoint," he said. "But this raises another important issue, which is that the use of screening in the younger age population has led to a lower rate of mastectomy due to earlier detection and the lower likelihood — by about 7% — of needing to employ postadjuvant chemotherapy."
Dr. Seidman noted that this was a "very important gain independent of any potential survival benefit."
"Having less disfiguring surgery and the ability to deliver less chemotherapy based on the diagnosis is a step forward," he added. "Undoubtedly this will remain an area of controversy for some, but women in this age group will be well served to know about this data."
Ignited Controversy
In 2009, the US Preventive Services Task Force revised their breast cancer screening recommendations, and the resulting document was in opposition to other existing breast cancer screening guidelines from organizations such as the American Cancer Society and the American College of Radiology.
The new recommendations ignited controversy among both patients and clinicians, explained Dr. Caughran. "They specifically recommended against screening mammography in women aged 40 to 49, and changed screening mammography beginning at age 50 to every other year, rather than annually," she said. "They also did not advocate for teaching women self-breast examination and also questioned the utility of clinical breast examination in women over the age of 40."
Lower Stage With Mammography
In this study, Dr. Caughran and colleagues sought to determine the effect of these new recommendations on diagnosing and treating breast cancer. They used data from a statewide breast cancer registry managed by the Michigan Breast Oncology Quality Initiative (MiBOQI), which included data from women at 17 statewide institutions, from 2006 to 2009.
The cohort included 5903 women with breast cancer, who were diagnosed at an average age of 59.4 years. There were at least 270 days of follow-up, Dr. Caughran pointed out, and patients with stage 4 cancer were excluded because they had incomplete data for analysis.
The majority of women whose tumors were detected by mammography (3869) were over age 50 years (81%). For women whose tumors were found by palpation (1759), 40% were under age 50.
Patients with palpable presentations were younger (55.8 years vs. 61.2 years; P < .001). Cancers with a palpable presentation were diagnosed at higher stages (50.0% stage II) than those diagnosed with mammography (52.5% stage I; P < .001).
"In that palpation group, it is important to note that 90% had a breast mass that they discovered themselves, compared to 9.8% discovered by a clinician," she said. "It's unclear if the patients who found the masses were practicing self-breast examination or they were incidental."
Women with cancers detected by mammography were more likely to undergo breast conservation surgery (palpation, 54.2%; mammography, 72.9; P < .001). Conversely, women with cancers detected through palpation were more likely to undergo mastectomy procedures.
The study does not represent an overall screening population, cautioned Dr. Caughran, because all these patients had breast cancer, and screening data were not available beyond 90 days before the date of diagnosis. "But we conclude that annual mammogram and evaluation of palpable breast masses are important tools of breast cancer detection."
2011 Breast Cancer Symposium. Abstract #1. San Francisco, California. To be presented September 8, 2011.
Highlights of the study were presented at a press briefing given in advance of the start of the 2011 Breast Cancer Symposium, being held in San Francisco, California.
In a cohort of almost 6000 women with breast cancer, 65.5% of breast cancers were detected by mammography, 29.8% by palpation, and 4.7% by other methods.
In women under the age of 50 years, approximately half of the tumors (48.3%) were detected by mammography, while a similar percentage of tumors (46.1%) were detected by palpation.
Almost all of the breast cancers detected by palpitation were detected by the patient, as compared with those detected by a clinician.
Of note, women with palpable tumors tended to have more advanced cancers, as compared with those whose tumors were detected by mammography, and this was applicable to women age 40 to 49 years and those over age 50, explained lead author Jamie Caughran, MD, medical director of the Comprehensive Breast Center at the Lacks Cancer Center in Grand Rapids, Michigan.
The authors also found that women with tumors detected by palpation were more likely to undergo mastectomy (46%) than those with tumors found via mammography (27%). Similarly, women with tumors detected by palpation were also more likely to undergo chemotherapy (22.7%) than those detected by mammography (15.7%).
Lower Rate of Mastectomy and Chemotherapy
This is very important work for a number of reasons, commented Andrew Seidman, MD, American Society of Clinical Oncology Cancer Communications Committee member.
"There has been controversy — depending on your perspective or data presented in individual studies or in large overviews — regarding the utility of screening in younger women," said Dr. Seidman, who served as the moderator of the press briefing. "We do know that younger women have denser breast tissue, which can impact or reduce the sensitivity as compared to older women. But it certainly doesn't negate the utility of mammography as a screening test."
Dr. Seidman pointed out that much of the debate and focus regarding the utility of mammography have been on its impact on overall survival and breast cancer–specific survival.
"That is certainly the most important endpoint," he said. "But this raises another important issue, which is that the use of screening in the younger age population has led to a lower rate of mastectomy due to earlier detection and the lower likelihood — by about 7% — of needing to employ postadjuvant chemotherapy."
Dr. Seidman noted that this was a "very important gain independent of any potential survival benefit."
"Having less disfiguring surgery and the ability to deliver less chemotherapy based on the diagnosis is a step forward," he added. "Undoubtedly this will remain an area of controversy for some, but women in this age group will be well served to know about this data."
Ignited Controversy
In 2009, the US Preventive Services Task Force revised their breast cancer screening recommendations, and the resulting document was in opposition to other existing breast cancer screening guidelines from organizations such as the American Cancer Society and the American College of Radiology.
The new recommendations ignited controversy among both patients and clinicians, explained Dr. Caughran. "They specifically recommended against screening mammography in women aged 40 to 49, and changed screening mammography beginning at age 50 to every other year, rather than annually," she said. "They also did not advocate for teaching women self-breast examination and also questioned the utility of clinical breast examination in women over the age of 40."
Lower Stage With Mammography
In this study, Dr. Caughran and colleagues sought to determine the effect of these new recommendations on diagnosing and treating breast cancer. They used data from a statewide breast cancer registry managed by the Michigan Breast Oncology Quality Initiative (MiBOQI), which included data from women at 17 statewide institutions, from 2006 to 2009.
The cohort included 5903 women with breast cancer, who were diagnosed at an average age of 59.4 years. There were at least 270 days of follow-up, Dr. Caughran pointed out, and patients with stage 4 cancer were excluded because they had incomplete data for analysis.
The majority of women whose tumors were detected by mammography (3869) were over age 50 years (81%). For women whose tumors were found by palpation (1759), 40% were under age 50.
Patients with palpable presentations were younger (55.8 years vs. 61.2 years; P < .001). Cancers with a palpable presentation were diagnosed at higher stages (50.0% stage II) than those diagnosed with mammography (52.5% stage I; P < .001).
"In that palpation group, it is important to note that 90% had a breast mass that they discovered themselves, compared to 9.8% discovered by a clinician," she said. "It's unclear if the patients who found the masses were practicing self-breast examination or they were incidental."
Women with cancers detected by mammography were more likely to undergo breast conservation surgery (palpation, 54.2%; mammography, 72.9; P < .001). Conversely, women with cancers detected through palpation were more likely to undergo mastectomy procedures.
The study does not represent an overall screening population, cautioned Dr. Caughran, because all these patients had breast cancer, and screening data were not available beyond 90 days before the date of diagnosis. "But we conclude that annual mammogram and evaluation of palpable breast masses are important tools of breast cancer detection."
2011 Breast Cancer Symposium. Abstract #1. San Francisco, California. To be presented September 8, 2011.
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